FAST MRI Research Programme

The FAST MRI research programme has been designed to find the most aggressive form of breast cancers sooner.

FAST MRI Logo

Mammograms are offered routinely every three years for women aged 50-70 years as part of the NHS Breast Screening Programme. Whilst mammograms are used to detect asymptomatic breast cancers, MRI scans are able to identify more aggressive cancers with greater ease. Unfortunately, MRI scans are expensive, and so the NHS uses them only to screen women at a high risk of developing breast cancer.

New evidence is suggesting that MRI scans can be abbreviated to reduce their cost to the NHS, without affecting their ability to accurately display breast cancers. FAST MRI is an abbreviated form of MRI which takes less time to acquire (3 vs 20 mins on the scanner) and to interpret (1 vs 10 mins).

Unlike mammograms, FAST MRI scans can also identify aggressive cancers irresepective of breast density a trait found more commonly in younger women. Therefore we are developing FAST MRI to concentrate on women who are having their first screening by the NHS Breast Screening Programme. 

FAST MRI Studies:

Reader Training Development: Single-Centre Study

Background:

Mammographic screening programmes result in both over diagnosis and under diagnosis of breast cancer. Under diagnosis leads to cancers presenting symptomatically between screening visits (interval cancers), and to continued presentation of Stage 2 or greater breast cancers. Although MRI is the most sensitive method to detect breast cancer, currently only women classified as high risk

(>30% lifetime risk) are offered screening MRI in the UK. However, in the future, personalised screening could enable larger numbers of women to be offered different screening regimes, each incorporating different imaging modalities, according to their level of risk. Finding breast cancer early saves lives, and there is therefore a need to develop cost-effective imaging tests that will benefit women at risk of breast cancer by finding significant disease early. First post-contrast acquisition subtracted (FAST) MRI is a type of abbreviated breast MRI and has been suggested as such a screening test since proof of concept studies suggest it could offer accuracy of breast cancer detection almost equivalent to full protocol breast MRI with speed of acquisition and reporting that approaches that of mammography. This technique might especially benefit women with dense breasts since cancers obscured by dense tissue on mammograms are often visible on MRI.

Aims:

The aim of this study was to explore whether NHS breast screening programme (NHSBSP) mammogram readers can learn to effectively interpret FAST MRI with less than one day’s additional training and to match the capabilities of expert breast MRI readers at this task in terms of accuracy and speed of interpretation.

Methods:

FAST MRI images were created by using previously acquired Full Protocol MRI scans. The anonymised imaged were reformat and simplified into a form equivalent in its display to a FAST MRI.

Using these FAST MRI images training was able to be offered to colleagues at North Bristol Breast Care Centre.

Four consultant radiologists who were qualified to report full MRI breast protocol and 4 screening mammogram film readers who had not previously been trained to report MRI were trained to read FAST MRI, by being shown a set of training images with answers in a one to one session with the Chief Investigator, and the length of time taken to train each will be recorded.

Results:

The findings showed that the brief structured training carried out in the study enabled multi-professional mammogram readers to achieve similar accuracy at FAST MRI interpretation to consultant radiologists experienced at breast MRI interpretation.

For more information about this study, published results can be found on the British Institute of Radiology website (main results), European Journal of Radiology website (training methodology) and the Pub Med website (review of published literature).

Funded by North Bristol NHS Trusts’ Research Capability Fund.

Project Details
Principal Investigator: Dr Lyn Jones
Study Completion: 26/02/2019
Local Ref: 4002

Reader Training Programme: Multi-Centre Study

Background:

After the promising results of the single centre study, the FAST MRI training programme was awarded an NIHR grant to expand and develop the FAST MRI training further.

Aims:

The aim of this study was to refine and pilot a training programme for FAST MRI interpretation within the NHS Breast Screening Programme (NHSBSP) workforce, to support the delivery of a future multicentre study of FAST MRI versus mammogram for breast cancer screening.

  • Produce an electronic version of a standard teaching tool and data collection tool working in close partnership with NHS based SciCom team (Workstream 1).
  • Pilot the standard teaching tool across 6 NHS sites within the South West region, UK and collect data on the accuracy and speed of FAST MRI interpretation following training (Workstream 2).

Methods:

  • Workstream 1: Production of electronic versions of a standard teaching tool and of a data collection tool.
  • Workstream 2: Pilot the standard teaching tool across 6 NHS sites (NHSBSP screening units) within the South West region of England (Truro, Plymouth, Taunton, Avon, Cheltenham and Swindon) and collect data on the accuracy and speed of FAST MRI interpretation following training. In addition, a Budget Impact Analysis to assess potential cost savings and affordability to the NHS will be carried out by the research team’s Health Economist as part of Workstream 2.
  • Training: The teaching tool will be used to train at least 12 readers from 6 centres to read FAST MRI. One day group training will replace the one-to-one training (used in the previous single centre study), made possible by the electronic teaching device.
  • Follow-up interview: All study participants who have given consent to be contacted for future studies will be emailed to invite them to take part in a follow up interview to find out more information about how the readers felt about the study.

Results:

Data analysis in progress.

Funded by the National Institute of Health Research (NIHR) Research for Patient Benefit funding stream.

Project Details
Principal Investigator: Dr Lyn Jones
Study Completion: 07/09/2020
Local Ref: 4543

Quality Assurance/Technical Development

Background:

To be able to get high quality FAST MRI images it is important that the correct protocol (information/sequences programmed into the scanner) is optimised. To do this test (phantom) breast need to be developed to trial the protocols to put into the MRI machine.  

Aims:

To develop breast test objects to ensure an optimum FAST MRI protocol (the information put into the MRI scanner to run the scan) and develop a quality assurance (QA) programme that can be used across different sites and MR scanner vendors.

Methods:

This phantom development work includes the design and construction of 2 magnetic resonance imaging (MRI) test objects that will be used for quality assurance (QA) tests of MR scanners at centres participating in the FAST MRI project.

One of these test objects will be used to assess the dynamic range of the dynamic contrast enhanced (DCE) sequence and the other the resolution in 3 dimensions. The MRI test objects will be trialled at NBT initially in order to finalise the design. 

Results:

Study in progress.

Funded by the National Institute of Health Research (NIHR) Research for Patient Benefit funding stream.

Project Details
Principal Investigator: Dr Lyn Jones
Planned End Date: 30/10/2022
Local Ref: 4543

Enhancing radiographer and MDT breast clinicians’ understanding of breast MRI: Mapping the learning curve of novice abbreviated breast MRI readers

Background:

Abbreviated-breast-MRI (abMRI) has been developed to address limitations of full-protocol-breast MRI (fpMRI)(time to acquire and report with associated cost and patient discomfort). AbMRI diagnostic-accuracy is similar to fpMRI and therefore has potential for wider use in screening but to roll it out on a larger scale more readers skilled in interpreting abMRI would be needed. Initial evaluation showed NHSBSP mammogram-readers could be trained to interpret abMRI with a single day of structured training.

Aims:

This study aims to evaluate the learning curve of novice readers reaching competence in abMRI interpretation.

Methods:

A cohort of mammogram-readers will undergo formative training and their learning curves plotted over time (diagnostic-accuracy and reading times). We wish to quantify the variation in learning for individual readers and explore remote formative training by e-learning in this cohort.

Results:

Study in set-up.

Funded through the National Breast Imaging Academy by Health Education England.

Project Details
Principal Investigator: Dr Liz O’Flynn
Planned End Date: 01/04/2022
Local Ref: 5041

Selection for personalised screening with FAST MRI: Evaluation of an Artificial Intelligence (AI) tool, developed within and owned by the NHS to accurately measure mammographic breast density (ENAID)

Background:

Finding breast cancer early saves lives. The NHS uses mammograms to try and detect early breast cancers. However, as mammograms do not show some cancers very well, a cancer can be missed and continue to grow until the woman finds it for herself. MRI (Magnetic Resonance Imaging) is a test that can find cancers better than mammograms, but it is expensive and so the NHS only uses it to screen women at very high risk of breast cancer. A quicker, shorter MRI test is now available called FAST MRI. Not only might this test benefit more women, it may also provide better value for money for the NHS to find breast cancers early and save lives. 

Every woman’s breasts are different. One way they differ is in their composition, which affects how they look on mammograms. Women with denser breasts can have their cancers missed on mammograms, as the dense normal tissue can hide the cancer. FAST MRI is better at finding these cancers.

To find out which women have dense breasts and could benefit from a FAST MRI, the mammograms need to be studied and measured. Currently, breast density is looked at and estimated by the radiologist but as each radiologist might view images slightly differently, results for breast density might not always be correct. There are now better systems to do this using (expensive) technology.

Aims:

To evaluate the accuracy and reliability of a breast density measurement tool. This will provide the National Breast Screening Programme (NHSBSP) with the ability to describe a woman’s breast density. If this tool is successful, it will further enable the North Bristol NHS Trust led FAST MRI research programme to develop a better breast screening programme.

Methods:

Our study will use an NHS developed and owned artificial intelligence (AI) software tool to automatically categorise the breast density. The cost to other NHS organisations will therefore be much lower when compared to commercial software. We will test our tool on anonymised mammograms, held in a research database called OPTIMAM, and compare the results to measurements made by commercial technology.

Our study will look at women aged 50-52, the age when women at average risk of breast cancer in the population are first invited to attend for an NHS screening mammogram.

Results:

Study in set-up.

Funded by Southmead Hospital Charity Research Fund.

Project Details
Principal Investigator: Dr Katherine Klimczak
Planned End Date: 01/04/2023
Local Ref: 5086

Further Info:

If you would like more information about the FAST MRI research programme, or would like to find out how you can get involved, please contact researchgrants@nbt.nhs.uk.

You can also get to know the researchers and support staff delivering this study by visiting the FAST MRI Research Team page.

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Email: research@nbt.nhs.uk